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FRACS True / False Quiz > 2017 group JAAOS 2020 > Flashcards

2017 group JAAOS 2020 Flashcards

1
Q

The failure rate of DAIR in infected TKR with virulent organisms (MRSA, VRE) approaches 80%

A

True

JAAOS March 2020

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2
Q

Extension of antibiotic duration in DAIR of infected TKR increases rate of cure

A

False

Does not increase rate of cure, only postpones failures

JAAOS March 2020

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3
Q

Systemic absorption of high dose abx from cements spacers in infected TKR persists for at least 8 weeks

A

True

JAAOS March 2020

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4
Q

There are few indications for spacer exchange in treatment of infected TKR

A

False

Indications:
Wound healing problems
Infection persists
Mechanical failure of spacer
Sinus drainage

JAAOS March 2020

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5
Q

Possible complications of cement spacers in TKR infection include mechanical instability and nephrotoxicity

A

True

JAAOS March 2020

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6
Q

The standard posterior viewing portal in shoulder arthroscopy is generally 5-6cm proximal to quadrangular space

A

False

It is 3-5 cm away, so axillary nerve is in danger

JAAOS March 2020

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7
Q

In iatrogenic nerve laceration following shoulder surgery, primary end-end repair should be performed within 7-10 days

A

False

Ideally within 72 hours. This is due to possible proximal end of nerve retraction (especially after 7 days), which will require interposition graft for repair and has worse outcomes

JAAOS March 2020

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8
Q

The portal of Neviaser places the axillary nerve at risk

A

False

Suprascapular nerve is at risk. The Navieser portal is the one between clavicle and acromion

JAAOS March 2020

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9
Q

Nerve injuries due to regional anaesthesia in shoulder surgery have a 99% rate of resolution at 1 year

A

True

JAAOS March 2020

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10
Q

Shoulder arthroscopy in lateral position has a reported rate of 10-30% of nerve traction injury

A

True

JAAOS March 2020

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11
Q

Beach chair positioning for shoulder surgery is associated with injuries to the greater auricular nerve and lesser occipital nerve

A

True

From head positioning

JAAOS March 2020

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12
Q

Early mobilization after rotator cuff repair (before 8 weeks) improves Patient Reported Outcome measures and Functional outcomes at 6 months.

A

False

No difference between early and late (>8 weeks) mobiliazation

JAAOS March 2020

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13
Q

High BMI and Diabetes are independant risk factors for poor Patient Reported Outcome measures after rotator cuff repair

A

False

BMI = no difference in PROs, but higher retear rate
Diabetes is indeed associated with poor outcomes

JAAOS March 2020

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14
Q

STT arthritis is associated with DISI deformity and type 2 lunate

A

True

JAAOS March 2020

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15
Q

STT arthrodesis has good fusion rate

A

False

Has a 4-30% non-union rate

JAAOS March 2020

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16
Q

STT OA is easily identified on preop xrays

A

False

Pre-op sensitivity is <50%, intraop inspection is mandatory

JAAOS March 2020

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17
Q

STT OA in 64% of patients with basilar thumb OA

A

True

JAAOS March 2020

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18
Q

If distal scaphoid excision is being performed for STT OA, at least 3mm should be resected

A

False

Yes, a distal scaphoid excision is an option, but excising more than 3mm increases the rate of DISI

JAAOS March 2020

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19
Q

Tandem stenosis occurs in approximately 1% of patients with symptomatic lumbar stenosis

A

False

10%

JAAOS March 2020

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20
Q

Congenital canal stenosis predisposes to tandem stenosis

A

True

JAAOS March 2020

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21
Q

Torg pavlov ratio of 0.78 in lumbar spine is also predictive of cervical myelopathy

A

True

JAAOS March 2020

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22
Q

In cervical & lumbar tandem stenosis, decompression of cervical spine may alleviate symptoms attributed to lumbar spine pathology also

A

True

JAAOS March 2020

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23
Q

A timed up and go test is a simple and useful adjunct to assess physical conditioning and muscle strength

A

True

JAAOS March 2020

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24
Q

Clindamycin is safer and equally effective in preventing infection in shoulder arthroplasty as compared to Vancomycin

A

False

Higher infection rate with Clindamycin. Same infection rate with Cephazolin and Vanco. Use Vanco if Penicillin allergy.

JAAOS March 2020 - Retrospective study

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25
Q

Rate of radial nerve palsy with humeral shaft fracture is 12%

A

True

Range 7-17%

JAAOS March 2020

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26
Q

Radial nerve palsies occur more commonly in comminuted fractures of the humerus

A

False

More common in distal third fractures, transvers or spiral, open fractures.

JAAOS March 2020

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27
Q

There is a better rate of recovery of secondary/ iatrogenic injuries compared to primary injuries

A

True

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28
Q

Only 1% of radial nerves were found to be incarcerated in humerus fracture at time of surgical exploration

A

False

10%

JAAOS March 2020

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29
Q

77% of patients get recovery of radial nerve palsy with expectant management

A

True

However, 89% recovery with early (<3 weeks) exploration.

JAAOS March 2020

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30
Q

Deep wound infection rate in nonidiopathic scoliosis (syndromic, congenital or neuromuscular) correction is around 20%

A

True

5% to 40%

JAAOS Feb 2020

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31
Q

The Spinalis dorsi, Latissimus dorsi and Iliocostalis make up the Erector Spinae group of muscles

A

False.

Spinalis dorsi, Longissimus dorsi and iliocostalis.

JAAOS Feb 2020

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32
Q

The Latissimus dorsi muscle is supplied by the thoracodorsal artery

A

True.

Thoracodorsal artery and nerve.

JAAOS Feb 2020

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33
Q

The Saline Load Test is more sensitive and specific than clinical judgement in the evaluation of traumatic arthrotomies

A

True.

JAAOS Feb 2020

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34
Q

CT scan has poor reliability as compared to Saline Load Test in the evaluation of traumatic arthrotomies

A

False.

CT has 100% SN and SP

JAAOS Feb 2020

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35
Q

The addition of Methylene blue increases the sensitivity and specificity of the Saline Load Test to nearly 100% in the evaluation of traumatic arthrotomies

A

False

Makes no difference

JAAOS Feb 2020

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36
Q

Post-operative “suction – irrigation” can decrease the need for re-operation and the rate of septic arthritis in the management of traumatic arthrotomies

A

False

Ineffective and increases infection

JAAOS Feb 2020

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37
Q

Obtaining cultures of traumatic knee arthrotomies is unreliable and unnecessary

A

True

JAAOS Feb 2020

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38
Q

Despite modern surgical techniques and antibiotics, the rate of septic arthritis in traumatic arthrotomies remains similar to the World War 1 era.

A

False

100% in WW1 to 0% in modern.

JAAOS Feb 2020

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39
Q

The first cervical sclerotome (proatlas) forms the apex of the dens, the posterior superior arch of the atlas, and the apical, alar, and cruciate ligaments

A

False.

The 4th OCCIPITAL sclerotome is the proatlas.

JAAOS Feb 2020

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40
Q

Anomalies of the odontoid process are more common in patients with congenital syndromes such as trisomy 21, Klippel-Feil malformation, and skeletal dysplasias

A

True.

JAAOS Feb 2020

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41
Q

Spinal cord MRI signal changes in the setting of an os odontoideum are an absolute indication for surgical fusion.

A

True.

JAAOS Feb 2020

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42
Q

The vertebral artery is at higher risk with C1 lateral mass screw placement than C1-C2 transarticular screw placement.

A

False.

C1 lateral mass screw – dorsal venous plexus = bleeding. C1-C2 transarticular screw = Vertebral artery

JAAOS Feb 2020

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43
Q

Venous serum lactate and troponin remain normal in Acute Compartment Syndrome

A

False.

They are both elevated and may assist in the diagnosis of ACS.

JAAOS Feb 2020

44
Q

A perfusion pressure (Diastolic – Compartment) of greater than 30 mmHg is safe to rule out Acute Compartment Syndrome.

A

True.

JAAOS Feb 2020

45
Q

Dual incision Fasciotomy is superior to single incision fasciotomy in the management of Acute Compartment Syndrome.

A

False.

No evidence to say one is better than the other.

JAAOS Feb 2020

46
Q

Negative pressure wound therapy delays the time to final wound closure and increases the need for skin grafting in the surgical management of Acute Compartment Syndrome.

A

False.

Decreases time to wound closure and reduces the need for skin grafting.

JAAOS Feb 2020

47
Q

Surgical Fasciotomy is contra-indicated in cases of Acute Compartment Syndrome with Irreversible Ischaemia

A

True.

JAAOS Feb 2020

48
Q

Female gender, primiparity, family history and breech presentation are known risk factors for Developmental Dysplasia of the Hip.

A

True

JAAOS Feb 2020

49
Q

The Lateral Center-Edge Angle (LCEA) of Wiberg for normal hips is in the range between 0 to 20 degrees.

A

False.

25-39 = normal,
less than 20 = DDH,
more than 40 = protrusio.

JAAOS Feb 2020

50
Q

The Sourcil angle of Tonnis is less than 10 degrees for normal hips.

A

True.

> 10 degrees = dysplasia

JAAOS Feb 2020

51
Q

The Anterior Center-Edge Angle (ACEA) of Lequesne as seen on the false-profile view of normal hips is in the range of 25 to 40 degrees.

A

True.

The ACEA measures anterior coverage of the femoral head. Values <20 are indicative of dysplasia, values >40 are indicative of FAI.

JAAOS Feb 2020

52
Q

The “cross-over” sign on an AP x-ray of the hip has low sensitivity, but high specificity for excess acetabular anteversion.

A

False.

It is associated with acetabular retroversion. But is not very specific.

JAAOS Feb 2020

53
Q

Gadolinium has been shown to become permanently deposited in brain tissues in patients without renal failure.

A

True.

However, the long-term effects of these deposits is unclear.

JAAOS Feb 2020

54
Q

Acetabular dysplasia in adults leads to increased articular contact stresses and femoral head subluxation.

A

True

JAAOS Feb 2020

55
Q

Labral hypertrophy is a common finding in adults with acetabular dysplasia and femoral head uncoverage.

A

True.

JAAOS Feb 2020

56
Q

Burnese Peri-Acetabular Osteotomy is an accepted treatment option in Adult Dysplasia of the Hip prior to the onset of arthritis.

A

True.

This is allegedly the most common acetabular sided osteotomy for adult DDH.

JAAOS Feb 2020

57
Q

Pelvic osteotomy for Adult DDH has a survivorship of 74% at 10 years and 52% at 20 years.

A

False.

88% at 10,
61% at 20,
29% at 30 (from one study),

92% at 15 and
74% at 18 (in more modern studies).

JAAOS Feb 2020

58
Q

Patients who have Total Hip Arthroplasty after previous Peri-Acetabular Osteotomy have higher rates of complications and revisions and lower Harris Hip Scores as compared to patient with no previous acetabular osteotomy.

A

False.

No difference.

JAAOS Feb 2020

59
Q

Morphologic differences of the proximal femur in adult patients with Hip Dysplasia include femoral neck shortening, wide femoral canal and femoral neck retroversion.

A

False.

Short neck, 
Anteversion, 
Narrow canal, 
Straight canal, 
Head aspericity.

JAAOS Feb 2020

60
Q

Preoperative opioid use is associated with higher morbidity and mortality following elective orthopaedic procedures?

A

True

JAAOS Apr 2020

61
Q

The CB1 cannabinoid receptor is found primarily in the peripheral nervous system?

A

False

Found primarily in the CNS on the neurons and glia cells of the brain and has a high affinity for THC

JAAOS Apr 2020

62
Q

Studies have shown that smoked cannabis is effective for neuropathic pain in patients with HIV?

A

True

JAAOS Apr 2020

63
Q

Chronic marijuana users have the same risk of lung cancer as tobacco smokers?

A

False

? increased risk ?

JAAOS Apr 2020

64
Q

Cannabis use has been associated with decreased mortality in patients undergoing major joint arthroplasty and femur fracture fixation

A

True

But higher risk of medical complications.

JAAOS Apr 2020

65
Q

Overlengthening the lateral humeral offset by as little as 5 mm can decrease range of motion and cause abnormal translation and increased subacromial contact?

A

True

JAAOS Apr 2020

66
Q

Stemless humeral implants are contraindicated in humeral head AVN?

A

False

relative indications are middle age with advanced arthritis, AVN or if a revision is expected within the patients lifetime

JAAOS Apr 2020

67
Q

A lesser tuberosity osteotomy is contraindicated due to risk of metaphyseal disruption

A

False

LT osteotomy may be performed, it just needs to be thin. Authors recommend ~2mm thick

JAAOS Apr 2020

68
Q

A commonly used method of determining lateral humeral offset is the distance from the base of the coracoid to the lateral aspect of the greater tuberosity

A

True

JAAOS Apr 2020

69
Q

Current evidence suggests superior clinical and radiographic outcomes of stemless implants compared to stemmed

A

False

no evidence of superiority. Equivalence at best in short to mid term studies

JAAOS Apr 2020

70
Q

Studies in the hip and knee arthroplasty literature have demonstrated a strong correlation between preoperative functional scores and clinical outcomes

A

True

JAAOS Apr 2020

71
Q

patients of low socioeconomic status undergoing shoulder arthroplasty have worse pre-operative function

A

True

JAAOS Apr 2020

72
Q

patients of low socioeconomic status undergoing shoulder arthroplasty have worse pre-operative pain

A

True

JAAOS Apr 2020

73
Q

patients of low socioeconomic status undergoing shoulder arthroplasty have lower rate of opioid use

A

False

JAAOS Apr 2020

74
Q

patients of low socioeconomic status undergoing shoulder arthroplasty have a higher rate of diabetes mellitis

A

True

JAAOS Apr 2020

75
Q

Elderly patients should be counselled that, compared to younger patients, they have an increased risk of mortality and increased risk of revision in Total Hip Arthroplasty.

A

False

Lower risk of revision

JAAOS Apr 2020

76
Q

There is a moderate recommendation against the use of glucosamine sulfate in hip arthritis

A

True

Does not improve symptoms

JAAOS Apr 2020

77
Q

There is a limited recommendation that general anaesthetic may have benefits over neuraxial anaesthesia in Total Hip Arthroplasty

A

False

Some evidence that Neuraxial may reduce complications

JAAOS Apr 2020

78
Q

The AAOS guidelines do not recommend one surgical approach over others in Total Hip Arthroplasty

A

True

JAAOS Apr 2020

79
Q

There is strong evidence against the use of intraarticular hyaluronic acid in Hip Arthritis

A

True

Does not improve symptoms

JAAOS Apr 2020

80
Q

Trauma is responsible for up to 39% of osteomyelitis

A

False

19%

JAAOS Apr 2020

81
Q

Penicillins and cephalosporins are bacterocidal

A

True

JAAOS Apr 2020

82
Q

Routine wound cultures are recommended at the time of initial treatment of open fractures

A

False

No evidence to support this

JAAOS Apr 2020

83
Q

There is no evidence of benefit for the continued administration of antibiotics beyond 24 hours after closure or definitive coverage of open fractures

A

True

JAAOS Apr 2020

84
Q

Fluoroquinolones should be considered in patients with type III open fractures and pre-existing kidney disease

A

True

The standard (aminoglycosides) are nephrotoxic

JAAOS Apr 2020

85
Q

Topical vancomycin powder may reduce the risk of surgical site infection in fixation of high risk open fractures

A

True

JAAOS Apr 2020

86
Q

Empiric antibiotic treatment for open fractures with severe tissue damage lasts for 7 days

A

True

JAAOS Apr 2020

87
Q

The force necessary for knee extension is directly dependent on the perpendicular distance between the patellar tendon and the knee flexion axis

A

True

JAAOS Apr 2020

88
Q

In patella baja, the patella is always in contact with the trochlea in extension

A

True

This is in contrast to a normal patella

JAAOS Apr 2020

89
Q

Congenital patella baja has three distinguishing characteristics: (1) distal positioning of the patella in the femoral trochlea, (2) shortening of the length of the patellar tendon, and (3) increased distance between the distal pole of the patella and the articular surface of the proximal tibia

A

False

Decreased distance betwen the distal pole and proximal tibia

JAAOS Apr 2020

90
Q

Retention of the infrapatellar fat pad may decrease the incidence of patella baja in total knee arthroplasty

A

True

JAAOS Apr 2020

91
Q

In true patella baja, both modified Insall-Salvati ratio and Blackburne-Peel ratio will be abnormally low. In pseudopatella baja, Insall-Salvati ratio will be normal, however, Blackburne-Peel ratio will be low

A

True

In pseudopatella baja there is no shortening of the patellar tendon

JAAOS Apr 2020

92
Q

The upper extremity is the site of almost 30% of all soft-tissue sarcomas

A

True

JAAOS Apr 2020

93
Q

Tumors of the scapula account for about 50% of primary bone cancers originating in the shoulder

A

False

20% scapula

JAAOS Apr 2020

94
Q

Functional results with the use of upper limb endoprosthesis for oncologic and non-oncologic indications are comparable

A

True

JAAOS Apr 2020

95
Q

Many series show excellent mid to long-term results for pain relief and function after resection and reconstruction with an upper limb endoprosthesis

A

True

JAAOS Apr 2020

96
Q

Resection of the axillary nerve is an absolute contraindication to endoprosthetic reconstruction

A

False

JAAOS Apr 2020

97
Q

Regarding the acetabular origin of the ligamentum teres; the most robust is the posterior band, which originates at the ischial end of the TAL

A

True

JAAOS Apr 2020

98
Q

The artery to the ligamentum teres (LT) most commonly arises from a branch of the lateral femoral circumflex artery

A

False

Obturator artery usually

JAAOS Apr 2020

99
Q

In running and jumping, forces of up to 10 times body weight may pass through the hip

A

True

JAAOS Apr 2020

100
Q

the squat position, the important lateral iliofemoral ligament is tight

A

False

It is lax. This is where the ligamentum teres may be an important stabilizing structure

JAAOS Apr 2020

101
Q

During reconstruction, the anteroinferior quadrant of the acetabulum should be utilised for graft placement

A

False

Antero-inferior is “zone of death”
PosteroSuperior or PosteroInferior is where to place graft

JAAOS Apr 2020

102
Q

Optimizing modifiable patient risk factors significantly reduces the risk of Periprosthetic Joint Infection

A

False

The evidence is unclear and this includes obesity.

JAAOS Apr 2020.

103
Q

Intra-articular injection prior to total joint arthroplasty may have a time-dependent association for increased risk of Periprosthetic Joint Infection

A

True

But this is based on Limited evidence

JAAOS Apr 2020

104
Q

The use of antibiotic cement in preventing Periprosthetic Joint Infection is supported in the literature for both hip and knee arthroplasty

A

False

Not supported for knee replacements

JAAOS Apr 2020

105
Q

Sonication of suspected Periprosthetic Joint Infection is not recommended due to a high false positive rate

A

False

JAAOS Apr 2020

106
Q

The use of gram stain to rule out Periprosthetic Joint Infection is not recommended

A

True

A negative gram stain does not rule out infection

JAAOS Apr 2020

107
Q

The use of serum CRP, ESR and IL-6 are strongly recommended by the AAOS in the diagnosis of Periprosthetic Joint Infection.

A

True

JAAOS Apr 2020

FRACS True / False Quiz (3 decks)

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